[Use of high dose intravenous immunoglobulin in neurologic disease]

Intravenous immunoglobulin has been used generally as a supplement therapy in hypogammaglobulinemia patients. Then it has been shown to be effective in the treatment of patients with thrombocytopenic purpura, and in the last decade, IVIG has been used in the treatment of many autoimmune and systemic inflammatory diseases. In neurologic diseases intravenous immunoglobulin (IVIG) exhibits immunomodulatory properties, depending on the Fc portion of immunoglobulin G. The number of diseases in which IVIG therapy is effective has been demonstrated by controlled clinical trials. The indications for IVIG therapy in neurologic diseases are in four groups: A+ - the basic indication, they have been demonstrated in controlled clinical trials, A - recommended but they have not been proved by clinical trials, B - confirmed by singular trials, C - recommended as a last resort: the indications have not been confirmed any trials. IVIG clinical effect has been shown in trials in patients with GBS, chronic inflammatory demyelinating polyneuropathy, dermatomyositis and multiple sclerosis. An optimal dose and the frequency of IVIG administration depend on the knowledge of the pathophysiology of autoimmune diseases and the mechanism of IVIG action.